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Creating Sticky Communities by Design Putting the Pieces Together Adirondack Rural Health Network

Creating Sticky Communities by Design Putting the Pieces Together Adirondack Rural Health Network Glens Falls, NY May 2011. Walking on a “sticky” crosswalk?. Topics for consideration:. Some perspective . . . A brief rant & the epidemics too few are recognizing.

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Creating Sticky Communities by Design Putting the Pieces Together Adirondack Rural Health Network

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  1. Creating Sticky Communities by Design Putting the Pieces Together Adirondack Rural Health Network Glens Falls, NY May 2011 Walking on a “sticky” crosswalk?

  2. Topics for consideration: • Some perspective . . . • A brief rant & the epidemics too few are recognizing. • A question of priorities, and five recommendations. • The stickiness problem & 3 Ps (programs, projects, policies). • Why it really matters! Enjoying downtown.

  3. Youthful recollections

  4. Not just my idea . . . 30-Nov-2009 The Australian, 14-Oct-2009

  5. The rant: America’s looming chronic disease apocalypse . . . US “Obesity Epidemic”Ogden et.al. JAMA 288 (14), Oct. 2002;Flegal et.al. JAMA 303 (3), Jan. 2010.

  6. Diabetes Prevention Program(DPP; New.Eng.J.Med., April 2002) Compared three treatments for nationwide cohort (3,000+) at risk for developing diabetes (elevated fasting glucose). • Control: Standard exercise and nutrition counseling; placebo. • Standard plus drug treatment: Metformin • Intensive lifestyle change: Nutritional training, 150 min./week physical activity.

  7. Diabetes Risk Reduction(Diabetes Prevention Program; NEJM, April 2002)

  8. My rant: Change the conversation.It’s not just an obesity epidemic. It’s an epidemic of physical inactivity and poor nutrition.* * Two of the three things most at fault for skyrocketing healthcare costs in the U.S.

  9. Rank the priority of these five activities: • America on the Move – national meeting. • Local planning board meeting; re: trail. • Belmont Health Fair – lead walks, etc. • Address Governor’s task force on the MA Highway Design Manual. • Nordic Walking (w/poles) fitness DVD.

  10. Health Fair: But how much, and what activity to recommend to average people?

  11. Surgeon General’s Report 1996 Physical Activity Guidelines 2008 www.health.gov/paguidelines • 150 minutes/week of moderate physical activity; more is better. • Any activity is better than none. • Can be broken up. • 300 mins./week for children. • Reduced risk for CVD, diabetes, osteoporosis, obesity, dementia in old age, clinical depression, a growing list of cancers. Getting exercise, or just getting home from school?

  12. But, Health Fair is #5 because: • Only reaches those who choose to show up! • And only a fraction of those may actually use the information. TN Public Health Assoc. meeting

  13. Recommendation 1: Think about scale & effectiveness. Ask the simple question: in how many people is this likely to actually change behavior?

  14. Nordic Walking benefits: • 20% - 40% boost in energy expenditure. • Increased upper body workout (arms, chest shoulders, back, abs). • Improved balance; reduced loads on feet, legs. www.leki.com www.nordicwalkingusa.com

  15. BUT: Nordic Walking?Another fitness fad? What about the “dork factor?” Or the stickiness problem?

  16. I know lots about “dorky” physical activity . . .

  17. Exercise ParticipationEffect of Short Bouts, Home Treadmills(Jakicic et.al., JAMA 282, 16) ?

  18. Exercise ParticipationEffect of Short Bouts, Home Treadmills(Jakicic et.al., JAMA 282, 16)

  19. Self-help vs. CommercialWeight Loss Programs(Heshka et.al., JAMA 289, 14; April 9, 2003)

  20. Leisure Time Physical Activity in the US (MMWR: 50(09), 166-9; 54(39), 991-4]

  21. Recommendation 2: Go for breadth—not just “exercise” for the actively inclined. We need increases in routine, daily physical activity for everyone.

  22. Nutritional corollary: Go for breadth—not just getting people onto “diets.” We need increases in routine, daily healthy eating for everyone.

  23. Pedometer-based “lifestyle” activity promotion: • Measure steps all day. • Determine your average daily steps. • Increase by only 10%-20% a week. • Keep gradually increasing . . . Key to Success: Keep a record!

  24. BUT . . . how has advising people to “take the stairs”worked?

  25. Energy ExpenditureLifestyle vs. Structured Activity(Dunn et.al., J. Amer. Med. Assoc., 281, 4)

  26. An approach to increasing daily physical activity . . . P.A.P.P.I. (?)

  27. Physical Activity Promotion through Predator Introduction

  28. Social Ecology ModelDeterminants of behavior changeSallis & Owen, Physical Activity and Behavioral Medicine. • Individual (readiness, efficacy) • Interpersonal (family, friends) • Institutional (school, work, HMO) • Community (networks, local gov’t) • Public Policy (transport, land use)

  29. Socio-ecological success: tobacco • Individual – education, medication • Interpersonal – 2nd hand smoke, kids • Institutional – work place bans • Community – smoke free policies • Public Policy – taxes, enforcement, advertising bans, SG’s warning label.

  30. vs.

  31. The “healthy” trip decision hierarchy*: *Is it even plausible? In the US nearly 25% of all trips are 1 mile or less; roughly 40% are under 2 miles! (Nat’l Household Transportation Survey, USDOT) Walk Bike Transit Drive

  32. Fine for some, but clearly not enough . . . Elizabethtown . . . we need communities where people are intrinsically active.

  33. Recommendation 3: We have to make active living & healthy eating the easier choices - actually safer, more convenient, less costly, and more fun than the alternative.

  34. Planning Board:Directly impacts local environmental factors.

  35. Denton TX Elizabethtown The factors that make stickier settings: Destinations within walk, bike, & transit distance. Sidewalks, trails, bike lanes, crossings . . . Inviting settings for bikes, pedestrians, & transit. Safe & accessible for all ages, abilities, incomes. CDC Guide to Community Preventive Services At: www.thecommunityguide.org

  36. Varied destinations in proximity. 1. Land use. Jr. High School E.g. post office, grocery, schools Compact neighborhoods Mixed use, multi-family. E’town & shared open space. Housing above, retail below. Hidden Diamonds Park

  37. Madison, WI corner store

  38. 2. Network is more complete with: • Presence of sidewalks, bike lanes, pathways. • Shorter blocks, cul-de-sac connectors, more intersections. • Access to trail, park, greenway, transit. Bunker Hill Park

  39. Transit riders are physically active. Besser, Dannenberg, Amer. J. Prev. Med., 29 (4), Nov. 2005. Aside from intentional physical activity: • Half of transit riders walk at least 19 mins. • 29% get at least 30 mins. of activity. • Minorities, poor (income <$15k/yr.), denser urban dwellers more likely to get 30+ mins./day.

  40. 3. Site design: Market Po Elizabethtown Which setting is more appealing for travel on foot or by bike? W. Carthage Pipestone

  41. Site design?Research & practice suggest: Buildings at the sidewalk, not set back; parking on street or behind. Trees, benches, water, awnings, lighting, scale. Details: bike parking, open space, plantings, materials. Austin, MN

  42. 4. Safety. Median islands Roundabout Engineering can dramatically improve safety. Increasing pedestrian and bike trips decreases overall accident & fatality rates. Curb extensions (Jacobsen P, Injury Prevention, 2003; 9:205-209.)

  43. 5. Community design & food systems? Community gardens (near schools, parks, senior housing); conserving farmlands; Community Supported Agriculture. Regulate fast food, drive-through locations. Farmer’s markets, green grocers, healthy corner stores.

  44. BMI, Fast Food Outlets & Car Ownership Inagami S, et.al., BMI, Neighborhood Fast Food and Restaurant Concentration and Car Ownership, Journal of Urban Health, Vol 86 (5). Estimated additional weight (lbs.) Density of fast food restaurants

  45. 5 elements of a healthier community: Bristol, TN Compact, varied village centers & neighborhoods. Good connections for walking & bicycling (& transit). Inviting designs & destinations. Safety & access for all. Healthy food is widely available, accessible, & affordable. www.activelivingresearch.org

  46. “But what about rural areas . . . ?” Suburbanization of AmericaUS population shift, 1950-1996(after Bowling Alone, R. Putnam, 2000) • Suburbia is steadily consuming the landscape . . .

  47. “Rural” housing . . . ? 2. Rural areas are where we can affect the shape of development before it’s done! (or just more suburbia?) And this . . . . . . Becomes more of this.

  48. Recommendation 4:Both the built and policy environments of the community matter, so work on improving them. Start by helping people realize what is “sticky” and why it matters to them.

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